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Sunday, April 20, 2014

UGANDA: Myths about circumcision help spread HIV

Is female participation in voluntary medical male circumcision of any value? Experiences from Uganda.

by John Byabagambi, MPH
Improvement Advisor, USAID ASSIST Project/URC
Uganda adopted voluntary medical male circumcision (VMMC) as part of
its comprehensive HIV prevention strategy in 2009. From its inception,
the service was designed to target males and most of the efforts were
focused on ensuring that as many males as possible were circumcised. In
December 2012, a PEPFAR interagency team conducted an external quality
assessment for the Uganda program and found several quality gaps. ...
there were various myths surrounding circumcision which led to negative
outcomes, and we believed that, by engaging female partners, we could
educate them about the process and improve outcomes for males undergoing
the procedure. Some of these harmful myths include: having
unprotected sex after circumcision promotes wound healing; a painless
post-circumcision penile erection is an indication of complete wound
healing; as a cleansing procedure, the first post circumcision sexual
encounter should be with a partner that will never come into your sexual
life again; and there are possibilities that lignocaine may affect
penile function and the sooner these effects are tested after surgery
through sexual intercourse, the better.

... Here is a service whose main goal is to reduce the chance of HIV transmission, but what is happening is that it’s
leading to behaviors that greatly promote HIV transmission because it
is promoting unprotected sexual intercourse for clients with fresh
wounds, which act as a direct entry portal for the virus!The myths encouraging even males who have been faithful to their partners to have multiple sexual partners
- a known risk factor for HIV transmission because of the belief that
they need to “cleanse themselves.” Through discussions with staff and
clients we learned that it was actually the female partners that were encouraging their male partners to have intercourse with other women so that they wouldn’t transmit the bad omen to them, the most common omen being that their foreskins would peel off.

Additionally, we heard complaints in which female partners were reluctant to allow their spouses to complete the mandatory six weeks of post-circumcision abstinence
to allow complete wound healing. Some circumcised clients reported that
when they would inform their partners about the period of abstinence,
their female partners would think that their partners were cheating on
them, and that it was untrue that they must abstain for that long.
...